Serum Malondialdehyde Level as a Predictor of Failure of Weaning from Mechanical Ventilation in the Neonatal Intensive Care Units

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Abstract Background Mechanical ventilation is a lifesaving treatment used in critical neonatal patients. It is indicated when the patient's spontaneous ventilation is insufficient to sustain life. Mechanical ventilation expedites and facilitates gas exchange, oxygenation, and CO2 removal. Despite advances in non-invasive ventilatory support methods, intubation and mechanical ventilation are still common treatments in NICUs. Objective To evaluate whether or not serum malondialdehyde (MDA), as a marker for oxidative stress, could be used as a mean to predict the neonatal weaning failure from mechanical ventilation. Methods This is a prospective cohort study included 31 full and preterm neonates on invasive mechanical ventilation ≥72 hours was conducted in Neonatal Intensive Care Unit Ain Shams University, children Hospital, after approval of the Research Ethics Committee Faculty of Medicine Ain Shams University from 1/3/2022 to 1/11/2022. Inclusion criteria of enrolled neonate includes full term (≥37 weeks) and preterm (33-36 weeks) neonates within their 28 days of life, neonates on invasive mechanical ventilation ≥ 72 hours and neonates ready to be weaned according to weaning Protocol. Results Serum level of MDA after half and 72 hours in weaning failure neonates (627 and 2000 ng/ml) compared to serum level of MDA pre-Spontaneous breathing test (SBT) (325.9 ng/ml) with p-value= 0.000. Serum level of MDA in weaning success patient pre-SBT, after half and 72 hours (163,124.2 and 63.9 ng/ml) compared to weaning failure patient (325.9,672 and 2000ng/ml) with p- value= 0.000. Our study revealed highly significant increase in serum level of MDA in weaning failure patients after half and 72 hours of extubation with p-value = 0.000. Pre extubation serum MDA level to Predict weaning failure was >223 ng /ml. Conclusion This study demonstrated significant increase in the level of pre-extubation serum MDA in the weaning failure group than weaning success. Serum MDA could be used as mean to predict weaning failure from mechanical ventilation.